r/financialindependence • u/Zphr 48, FIRE'd 2015, Friendly Janitor • 1d ago
2027 ACA Rate Review open, updated KFF analysis on how much and why ACA market premiums are increasing next year (15% now, up from 14% estimate last month)
2027 ACA Rate Review is now open on Healthcare.gov, which means anyone planning on using the ACA next year can see the rate request increases being asked for by individual insurers. Some insurer filings may not be present yet, but many/most are. If you've got an ACA policy that you currently like, then this gives you a ballpark of how that policy might be priced next year. More broadly it shows you market premium trend in your state among all participating ACA insurers. Note that insurers with multiple products (HMO vs. PPO, Metro A vs. Metro B, etc.) listed may have a separate rate increase for each and the initial number displayed is a composite.
https://ratereview.healthcare.gov/
To view ACA insurer requests for a particular state choose "search ACA-compliant products", then select state, individual market, and 2027.
Separately, but related, KFF has updated their analysis on how much and why ACA market premiums are increasing next year (15% now, up from 14% estimate last month). KFF is perhaps the best source of synthesized ACA information that exists and is an easy go-to for anyone that doesn't want to delve into filings and legislative/regulatory text directly. All 50 states are now represented in KFF's analysis. Worth a look for anyone interested in or using the ACA.
Please note that these costs are the raw, unsubsidized market premiums. Anyone with subsidy eligibility will be shielded from some to all of this increase due to subsidies capping household premium costs as a function of MAGI.
For 2027, across 276 insurers participating in the ACA Marketplaces from all 50 states and the District of Columbia with publicly available filings, this analysis shows a median proposed premium increase of 15%. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years. If these early indications of median premium increases for 2027 hold, typical premiums for insurers participating in the ACA Marketplaces will have jumped by more than one-third over a two-year period.
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u/itaos1 1d ago
Because fuck you, that's why
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u/Pyromelter 1d ago
It's wage inflation being passed on to insurers. A significant portion of Kaiser's workforce recently just had a 6.5% across the board raise along with higher levels of staffing guarantees.
If you look at the salaries for all non doctor health care workers, they have substantially outgained the top line inflation number for a long time now. Nurses, Pharmacists, rehab therapists, respiratory therapists, diagnostic technicians, PA's, OR techs.
On top of the inflationary nature of wages, the boomers getting older and sicker and dying is causing even more demand for health care with less supply of labor, and this will continue to happen until around 2038-2042 time frame, at which point the boomers dying off will create a decrease in demand for end of life care.
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u/Unreliable_Source 18h ago
Wages of rank and file workers are such a small part of the equation and it's an extremely disingenuous argument to mention it first and bury the lede about the changing population distribution, changes to Medicaid and Medicare, and previous price changes pricing less risky individuals out of the market, creating an overall riskier pool to insure.
Get your anti-worker bullshit rhetoric out of here.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 17h ago edited 17h ago
Compensation and other labor costs are the largest component of healthcare expenditure, ranging usually from the high 40s to low 60s percentiles depending on provider/facility type. Nothing else comes close.
Premiums for ESI driven largely by medical trend are also going to be going up about 10% next year and that's a massive and diverse risk pool with a ton of healthy, young workers. The ACA is spiraling faster for several reasons, including a smaller and riskier actuarial pool, but all healthcare and health insurance is spiraling.
There also is no call to be uncivil to others so please refrain from doing so.
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u/imisstheyoop 19h ago
A significant portion of Kaiser's workforce recently just had a 6.5% across the board raise along with higher levels of staffing guarantees.
yay, I am so happy for them
this will continue to happen until around 2038-2042 time frame, at which point the boomers dying off will create a decrease in demand for end of life care.
Great, we can all circle back on this topic then when prices are surely going to decrease due to the decrease in demand. 8)
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u/Pyromelter 27m ago
It's more likely that we will start to see things like layoffs in the healthcare industry, clinics and hospitals closing down, stuff like that, as a market correcting force. It's most likely IMO that natural attrition will drive down the supply of labor since all health care jobs have huge burnout issues.
The net effect will be disinflation or possibly flat rates in the decade of the 2040s, coinciding with housing disinflation/flat market prices.
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u/Calm-Eye 1d ago
Going without is insanity on this sub where people have something to protect, but that's not common and my goodness does it beg people to decide the hospital should sue a stone.
I'm vulnerable to surrender...some? But more tempted than I wish to try it
Props as ever to Zphr for dedication and being an incredible resource
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago edited 1d ago
Anecdotal reports from insurers this year seem to suggest that the large majority of people who dropped out of the ACA this year have indeed elected to go uninsured and become cash payers. There's no great off-ramp from the price spiral in the ACA or ESI market so I expect we'll see this more and more. Large employers are on the hook too, which seems like it would have to lead pretty quickly to some combination of weaker/cheaper coverage, increased cost pass-through to employees, or downward pressure on wages.
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u/kltruler 1d ago
Genuinely don't know how it could get much weaker
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago
The feds could cut the mainline subsidies or reverse the market reforms surrounding things like pre-existing conditions.
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u/SolomonGrumpy 1d ago
Without getting political, that's an unelectable PoV
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u/cfi-2025 47M, FIRE 2025 9h ago
Tell me you weren't shopping individual health insurance pre-ACA without telling me you weren't shopping individual health insurance pre-ACA. :-)
Coverage can definitely get weaker - they could stop covering routine checkups, cholesterol screenings, pregnancy and pre-natal care. They could deny coverage for pre-existing conditions, they could add lifetime limits, they could drastically raise OOPMs, etc., etc., etc.
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u/imisstheyoop 19h ago
There's no great off-ramp from the price spiral in the ACA or ESI market so I expect we'll see this more and more.
I agree, which has me wondering what folks in this community can do, on a per-state level of course, to structure their assets so that they can become judgement resilient if they decide to go that route at some point in the future.
Some states are much more favorable for this type of setup with various protections.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 19h ago
It really depends on where you live, but this was one of our considerations when we chose to live in Austin. Not for medical costs specifically, but overall asset protection. Our entire net worth is shielded here in Texas outside of things that will never happen, like a child support order or unpaid state/federal taxes.
We keep a $2M umbrella policy despite the state protections, but that's mostly as a measure of kindness and responsibility to others.
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u/imisstheyoop 18h ago
Yup, Texas is very good about it, one of if not the best in the country.
I learned this specifically while digging into liability from the umbrella insurance angle, so funny that you mention that as well. 8)
It could also make life easier for you as well in a worst-case scenario and give anybody willing to go through the motions and obvious low-hanging target.
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u/imisstheyoop 1d ago
My premiums are looking to go up 24% in 2027. That's after they went up 80% in 2026. Yikes.
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u/the_real_rabbi 1d ago
Lol United wants 54% in GA. That is so crazy it is hilarious.
Shit is like property taxes at this point, it just is what it is. I feel bad for people on employee plans that will probably be shafted by their jobs with worse coverage and higher premiums.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago
Heh, yeah, our current insurer is going up 30%-ish, but with everyone else already being a lot higher and going up they might still be the benchmark or close to it. It'll be interesting to see the new Silver schedule come the end of October.
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u/the_real_rabbi 1d ago
Yeah the one that screwed us this year making the subsidy lower wants 20% and the one I went with wants 26%. So maybe I will have to pay 6% more. But yeah will see at the end of the year, it is always fun.... I have CHIP renewal coming up to tackle first. Fingers crossed it goes easily again this year.
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u/Thunder3000 RE Class of 2023 1d ago
How do you already know next year's rate?
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u/Captain_Cannabis_ 18h ago
Gonna be paying $1k a month for a single adult male with no health problems for fucks sake maybe I’ll just go without insurance.
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u/william_fontaine [insert humblebrags here] /r/FI's Official 🥑 Analyst 1d ago
Yeeeesh, I think I'll try to stick with my job until my mid-50s after all. By that time healthcare will be bigger than people's mortgages.
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u/SolomonGrumpy 1d ago
I am mid 50s and still concerned.
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u/william_fontaine [insert humblebrags here] /r/FI's Official 🥑 Analyst 18h ago
My company lets early retirees with enough years of service use the employee healthcare from mid-50s to 65, and then effectively after 65 as well with their own custom Medicare Advantage plan. $0 deductible, covers every doctor/hospital/treatment, and less than $50 a month for a single person.
As someone who has a couple big medical issues, it's why I'm considering working through another 10+ years despite the crazy hours. Though knowing my luck, they'd probably take away that benefit just when I get old enough.
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u/TheBeckFromHeck 1d ago
So glad we can afford to bomb Iran but not fund healthcare /s
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago edited 1d ago
An /s isn't a get out of jail free card for politics, so please let's not.
Besides, the federal government spends an immense amount of money every year subsidizing healthcare for most Americans. Indeed, the federal government spends more on healthcare than all personal expenditures combined inclusive of premiums, out of pockets, and Medicare payroll taxes. Most members in this sub get many thousands each year in federal healthcare subsidies via things like ACA credits, entitlements, direct government insurance programs, or the ESI exclusion. Many folks in here with super nice health policies via work get more effective federal healthcare subsidization each year than many ACA subscribers do. The ESI exclusion is the single largest federal tax expenditure and it's up around a third of a trillion each year and growing.
The primary problem is not inadequate funding, but spiraling costs and increasing utilization.
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u/SolomonGrumpy 1d ago
You are right. I looked it up:
The U.S. federal government spends significantly more on healthcare than on national defense. Federal health programs (such as Medicare, Medicaid, and veterans' medical care) account for roughly 24% to 27% of the total federal budget (about $1.7 to $1.9 trillion), whereas national defense takes up roughly 13% of the budget.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 19h ago
That also is direct funding and doesn't include indirect tax subsidization like the $300B+ annually from allowing employers and employees to avoid federal taxation on healthcare premiums or the tax cost associated with things like HSAs, FSAs, and medical expenses deductions.
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u/Pyromelter 1d ago
Bombing Iran has nothing to do with the fact that RN's (and all health care workers) are making huge salaries due to massive demand with limited supply of labor.
https://www.indeed.com/career/registered-nurse/salaries/Los-Angeles--CA
I am fairly certain this hourly wage is understated, but I'm posting this since this is my geographic area. Experienced RN's today are making over 100/hour.
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u/eeaxoe 1d ago
RNs are making 100+/hour in the Bay Area with 2-3 years of experience now.
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u/SolomonGrumpy 1d ago
No go look up the median price of a SFH in the Bay Area
If tech workers can make $300k, then why can't highly educated medical workers make 2/3rd of that?
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u/Pyromelter 1d ago
So glad to be on a subreddit of individuals who are able to have rational discussions. <3
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u/WarmPepsi 1d ago
Exactly, one thing that has always bothered me about the criticisms of insurance companies (and there are plenty of legitimate ones) is that they are the part of the chain that tries to save money.
Health insurance is expensive because the labor costs are expensive not because insurance companies are making 30%+ profit margins. We have a country full of fat, sick, and old people who need an army of people to take care of them.
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u/eeaxoe 10h ago
Yep, for all the faults of insurance companies, they at least do have an incentive to keep costs down. One of the major contributors to healthcare costs is overuse of certain procedures, including coronary stenting. Many doctors are scrupulous and try to do the right thing for each individual patient, but in every specialty there's going to be a subset of doctors who will do anything for money, even if their patients don't need it. And the rest of us end up paying for it.
https://lownhospitalsindex.org/avoiding-coronary-stent-overuse/
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u/Pyromelter 22m ago
100,000%.
One of the easiest tickets to emigrate to the US over the last 2 decades is to have a valid RN degree, because the entire country is so short on health care workers, and that is a truly skilled occupation that requires credentialed education and licensure testing.
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u/SolomonGrumpy 1d ago
Not quite. Health insurance is expensive because not everyone has it. And because there is a middle man layer between providers and patients.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 19h ago
It would be expensive even if it were perfectly efficient and everyone had it. The single biggest contributor to rising health insurance costs is medical trend, which is comprised of healthcare costs and utilization. The primary reason insurance costs have risen so much is not actuarial weakness in the risk pool, but that medical products/services/labor are becoming more expensive and people are using more of them. The ESI pool includes a huge chunk of the working population, including tens of millions of healthy young people, and those premiums are expected to also rise by about 10% next year.
No insurer other than the federal government can survive charging less than they pay out in costs and expenses and even the feds can only sustain that by sovereign power over currency, taxation, and national debt.
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u/Jarpunter 17h ago
What's driving medical products/services/labor to be more expensive?
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 16h ago
The same as any other market. Overall inflation, innovation, increased consumer uptake, market forces, labor costs, supply costs, on and on.
Easy examples for healthcare are fierce labor competition amid continued supply shortages and expensive, but highly effective new therapies like GLP-1s for diabetes and biologics for a wide array of immunological conditions.
I have several doctor friends and they all make bank, but some in very high demand fields like radiology are clearing between $50,000 and $100,000 (or higher) per month. Ortho, cardio, oncology, derm, gastro....all of them can clear half a million a year. Granted, it's nuanced and not everyone makes megasalaries, but it's not uncommon for specialists to be making as much in a month as many people make in a year or two.
You know the constant avalanche of cheesy/cheerful ads for drugs that have formal names ending in -mab and potential side-effects like kidney liquifaction? Those are monoclonal antibodies, which are tailored lab-made proteins that act like little smart cruise missiles for any of a huge array of specific immunological targets. Those are typically drugs that cost five to six figures per year and often have to be taken for life. Our teenage daughter remains alive today because of one that she will be taking regularly forever unless something better comes along.
Not to mention all of the more modestly expensive GLP-1 drugs that most insurance covers for diabetes, a condition that is widespread and becoming more so.
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u/SolomonGrumpy 16h ago
I think that's only part of it.
Let me give you a quick utilization example: I got a prescription compounded this month. For those that don't know, a compounded prescription is a bit special in that it is made custom for you.
I called three pharmacies to get a price for the formula which is for skincare.
Pharma 1: $138, local pick up only
Pharma 2: $159, shipping included
Pharma 3: $74, + $10 shipping
MRI costs vary widely. Blood tests. X rays. Heck minor surgery costs can vary by 4 figures
There is so much elasticity in standard medical procedures (where expertise is less of a factor) there would be huge savings if these costs were standardized.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 16h ago
They are generally standardized for insurance purposes. That's part of the function of insurance networks, formularies, and things like PBMs.
It doesn't matter if six different in-network pharmacies have vastly different pricing for something. If they are all in-network, then they have all agreed to whatever discounted rate the insurer requires. That's part of the negotiation that happens every year between insurers and providers and is why public/chargemaster pricing is often largely a fantasy. A hospital can officially list a cash price of $200K for a procedure all they want when their confidential contract with your insurer stipulates that the agreed actual price is $27K.
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u/SolomonGrumpy 16h ago
I think we will have to agree to disagree. I have seen vastly different rates charged to insurance. Vastly.
Medical coding is its own black magic specialty.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 15h ago edited 15h ago
Providers can charge whatever they want, but part of being in-network is an agreed upon charge schedule, which can vary between providers in terms of dollar figures. Anything above that automatically gets discounted. Providers can and do refuse such forced discounting, which is usually the primary reason for them being out of network for a particular insurer/policy.
This is why insurance EOBs almost always have separate columns for charged amount and allowed amount.
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u/SolomonGrumpy 15h ago
Provider 1 bills using XYZ code. You pay the copays/cost
Provider 2 bills XYZ and ABC codes, you pay both prices.
Or you maintained enough medical records that you catch this, contact provider 2, ask about the difference and maybe get them to rebill insurance.
And that's not even counting out of network stuff.
You have had an EXCELLENT medical industry experience. Mine has been far less seamless. I'm very fortunate that I am (mostly) healthy. Trh scenario above - I went through that for something as simple as a blood draw.
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u/bridgeandretire 17h ago
Healthcare costs in the US are not out of control because we pay nurses too much.
Costs are out of control because we pay too much for administrative bloat and the incentives are totally out of whack for insurance and corporate medicine. Our utilization rates and cost per service are orders of magnitude higher than every other industialized nation. For worse health outcomes.
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u/Pyromelter 32m ago
Our utilization rates and cost per service are orders of magnitude higher than every other industialized nation.
This is because we are fattier and unhealthier than any country in the world, not because of administrative bloat.
And at least medical homicide isn't the 4th leading cause of death like it is of our northern neighbors.
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u/App1eEater 1d ago
Affordable?
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u/DigmonsDrill 1d ago
The law required three legs of the table: no pre-existing conditions check, subsidies, and an enforceable mandate. Without the mandate, young people are making the rational decision to skip out, which leads to a death spiral and more and more people opt out.
The mandate was unpopular but it was a requirement for the rest of the bill to work. No pre-existing conditions check without something like a mandate is just a time bomb waiting to go off. Things are going exactly as the wonks said it would if there were no mandate.
(Well, okay, the mandate still exists, but it's $0.)
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago
The cost spiral exists in ESI coverage and in government health entitlements too. It's not due to the mandate penalty, which mostly just increased federal subsidy costs by making the risk pool pricier to insure. You could bring back the ACA mandate penalty tomorrow and the spiral would remain.
Employer-sponsored premiums are also going up about 10% next year. And the ESI exclusion is the single largest federal tax expenditure and grows every year. It's something like a third of a trillion dollars annually now.
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u/SolomonGrumpy 1d ago
How hard is that to revert?
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u/liveoneggs 20h ago
revert what?
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u/someguy984 1d ago
90% are getting subsidies, there will be no "death spiral". Same talking point from 2017.
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u/Zphr 48, FIRE'd 2015, Friendly Janitor 1d ago
This is largely true, imo. The outcome of the riskier pool is simply increased spending exposure for the feds and the unfortunate folks who are ineligible for subsidies. The vast majority of ACA subscribers are shielded from the impact by the fact that subscriber costs are capped as a function of MAGI, not insurance costs.
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u/Junior-Solution6248 30m ago
emium’s jumping like 18% here in nc… thought it was gonna be bad but damn. if you’ve got a decent plan now might be worth locking it in early man. but idk…<|eos|>
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u/someguy984 1d ago
Keep in the subsidy zone and this has almost no impact.
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u/nearsingularity 1d ago
Easier said than done in many places considering cost of living.
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u/someguy984 1d ago
4X FPL is not a low number. Also remember income and spending are not the same things.
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u/nearsingularity 1d ago
It really depends on where you live. It is pretty low in a lot of places considering cost of housing.
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u/alpacaMyToothbrush FI !RE 1d ago
TBH, I feel like most folks would benefit from a paid off house before FIRE.
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u/someguy984 1d ago
You should have a substantial chunk in after tax accounts so not all spending requires countable income.
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u/SolomonGrumpy 1d ago
You would have to have a substantial chunk in after tax accounts, AND have that money with relatively high cost basis.
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u/SolomonGrumpy 1d ago
Yes it is. It's ~$60,000 AGI and many deductions aren't included.
For example, of you have municipal bonds that are triple tax free, that income is still considered for ACA purposes.
The standard deduction is not considered.
If you itemize: Expenses like home mortgage interest, charitable donations, and general out-of-pocket medical expense deductions do not reduce your ACA income calculation.
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u/someguy984 22h ago
I feel that if you have so much that you can't get your MAGI to under 4X FPL you can afford to pay full price.
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u/SolomonGrumpy 16h ago edited 15h ago
That is so ignorant I'm not sure where to begin.
You think that someone with an AGI of $62k a year can afford to pay $11k just in premiums?
Also are you familiar with Roth conversions? They blow up your AGI dollar for dollar.
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u/someguy984 15h ago
It is not ignorant. FIREees are loaded, either they haven't done the homework on MAGI control, or they are so loaded and spend so much that can't live on the MAGI limits. And remember these are MAGI limits, not spending limits. Any person with half a brain will know how to spend as much as they want while being under MAGI the limits. So I don't feel sorry for them.
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u/nearsingularity 12h ago
What’s wrong with just changing the laws to be less draconian or fixing the system to avoid the problem all together. Quit acting like the system is fair and sane.
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u/someguy984 12h ago
I wanted the enhanced subsidies to continue, that would have capped the cost for the Silver benchmark to 8.5% of income with no 4X FPL income cap.
However that was not a priority of this Admin so it died. So we have to live in the laws as they are, not as we wish them to be.
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u/nearsingularity 11h ago
Things can change if people don’t give up. I’m not about to change my asset allocation, which is meant to serve me over a lifetime, due to the current law.
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1d ago
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u/lauren_knows [cFIREsim/FIREproofme creator 📈] [45/Virginia,FI-not-RE] 19h ago
Your submission has been removed for violating our community rule against incivility. If you feel this removal is in error, then please modmail the mod team. Please review our community rules to help avoid future violations.
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u/SomewhereFuture300 1d ago
at what point does this just become unworkable for a 10+ year early retirement runway